Healthcare Provider Details

I. General information

NPI: 1750297495
Provider Name (Legal Business Name): CHIMEZIE UDEAJA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 PRIEST BRIDGE DR STE 1
CROFTON MD
21114-2472
US

IV. Provider business mailing address

2110 PRIEST BRIDGE DR STE 1
CROFTON MD
21114-2472
US

V. Phone/Fax

Practice location:
  • Phone: 443-937-4089
  • Fax: 443-292-4570
Mailing address:
  • Phone: 443-937-4089
  • Fax: 443-292-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA01232
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: